Illicit Fentanyl Seizures Increased Nearly 2000% Within 7-Year Period in US


Study results suggest a nationwide increase in the supply and availability of illicitly manufactured fentanyl, with pills becoming more dominant across the ever-shifting US fentanyl market.

The total number of illicit fentanyl seizures by law enforcement in the United States surged by more than 1700% between 2017 and 2023, according to new data published in the International Journal of Drug Policy.1

Unidentified pills and powder over American flag / Tim -

Unidentified pills and powder over American flag / Tim -

In 2023, a staggering 115.6 million fentanyl pills were seized, representing nearly half (49%) of all seizures in the nation. This marks a dramatic 4-fold increase in pill seizures compared to just 7 years prior—a change that underscores an alarming trend in the opioid epidemic.

Key Takeaways

  • There was a massive surge in fentanyl seizures by law enforcement between 2017 and 2023, with the total number of seizures increasing by over 1700%.
  • In 2023, nearly half (49%) of all fentanyl seizures were pills. Fentanyl pills are especially dangerous because they can be easily mistaken for legitimate prescription drugs, creating a significant risk of accidental overdose.
  • The West currently has the highest fentanyl seizure rates compared to other regions in the US, but others are catching up. This suggests a nationwide spread of illicit fentanyl, with pills becoming more dominant.

“About half of seized fentanyl is now in pill form, suggesting that the illicit drug landscape has rapidly changed,” said Joseph J. Palamar, PhD, MPH, lead study author, associate professor in the Department of Population Health at NYU Langone Health, and deputy director of the National Drug Early Warning System.2 “Fentanyl in pill form not only makes it easier for people to initiate use, but also increases the chances that people who buy illicit pills could be unintentionally exposed to fentanyl since it is commonly present in counterfeit pills pressed to resemble oxycodone, Xanax, or even Adderall.”

Although rates of synthetic opioid-related deaths over time and across regions have been widely evaluated, investigators hypothesized that other indicator data could lend important insights into guiding prevention and harm reduction efforts in the illicit fentanyl landscape, as well as understanding overdose mortality trends. To gather this data, investigators compared how fentanyl seizures differed across regions in the US.

READ MORE: Fentanyl Education, Prevention Key to Ending Crisis in US

Annual trends in fentanyl seizures, both nationwide and stratified across the West, East, South, and Midwest, were gleaned from the High Intensity Drug Trafficking Areas program from 2017 to 2023. Investigators measured seizures across 8 indicators, which included the number of powder seizures; the number of pill seizures; the total weight of seizures; the number of pills seized; and the percentage of the number of pill seizures relative to the number of total seizures.

Overall, the number of fentanyl seizures increased from 1305 in 2017 to 23,529 in 2023, representing a staggering 1703.0% increase (adjusted annual percentage change [AAPC], 60.7; 95% CI, 47.6-74.9). This translated to a total weight of 42,927.3 kg of fentanyl and 177,535,917 fentanyl pills seized in the 7-year time frame.

Across different forms, the number of seizures of powder fentanyl witnessed a 923.1% increase (AAPC, 47.2; 95% CI, 25.6-72.5) from 2017 to 2023, and the number of seizures of pill-form fentanyl witnessed an 8509.7% increase (AAPC, 107.7; 95% CI, 98.4-117.5) during the same period.

Fentanyl seizures were highest in the West compared to other regions across 7 out of 8 measures. Only the South beat out the West for the highest number of powder seizures, although the West exceeded the South’s total powder weight of fentanyl seized. Interestingly, despite leading the nation in powder weight, pills dominated the West’s fentanyl seizures, accounting for 77.8% of all confiscated fentanyl in the region.

Investigators observed a concerning trend: while the West has historically led in pill seizures, other regions are catching up. This suggests a nationwide increase in the supply and availability of illicitly manufactured fentanyl, with pills becoming more dominant across the ever-shifting US fentanyl market.

“The increase in the West was a large geographic shift considering that the fentanyl crisis originated in New England and in parts of Appalachia, with Arizona being the only western state originally having a high number of fentanyl seizures,” wrote researchers.

Fentanyl—a synthetic opioid up to 50 times stronger than heroin and 100 times stronger than morphine—has been increasingly linked to a “third wave” of the opioid epidemic. In 2022, 70% of over 109,000 drug overdose deaths were attributed to the drug, underscoring the urgent need for a multifaceted approach to combat the crisis.3

The current study reveals critical changes in the fentanyl landscape that could shape important intervention efforts. By understanding regional trends associated with the use of fentanyl, public health experts can target harm reduction programs toward fentanyl “hot spots.” Regional insights can also empower law enforcement to disrupt trafficking networks with greater precision. Further, analyzing regional trends in fentanyl seizures can guide national and regional policymakers on public awareness campaigns and resource allocation.

READ MORE: Substance Use Disorder Resource Center

1. Palamar JP, Fitzgerald N, Carr TH, Cottler LB, Ciccarone D. National and regional trends in fentanyl seizures in the United States, 2017–2023. Int J Drug Policy. Published online May 13, 2024.
2. Dramatic increase in fentanyl seized by authorities in last six years. News release. EurekAlert. May 13, 2024. Accessed May 13, 2024.
3. Tanz LJ, Gladden RM, Dinwiddie AT, et al. Routes of drug use among drug overdose deaths—United States, 2020-2022. MMWR Surveill Summ. 2024;73(6):124-130. doi: 10.15585/mmwr.mm7306a2
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